Revised 12-2015 MVC Application for Oklahoma Certificate ...

1 Application for Oklahoma Certificate of Title for a VehiclePlace Motor Vehicle TaxStamp HereForm 701-6 Revised 12-2015 MVCM odel Year and Make: _____ Body Type: _____Identification Number: _____Model: _____Enter Number of Tires for Each Rim Size (including spare tire, if applicable):Tire Rim Size: _____ or less _____Over _____ MotorcycleIf a previously titled vehicle being brought into Oklahoma by an Oklahoma resident, list the date the vehicle entered Oklahoma . If a previously titled vehicle being brought into Oklahoma by a new resident, list the date of the new resident s employment in this state: Entry Date: _____ Employment Date: _____Owner Name: _____Address: _____ City: _____State: _____ ZIP: _____Drivers license number of owner or, if owner is not an individual, the owner s Federal Employer Identification Number: _____This vehicle is subject to a lien in favor of:Name: _____Address: _____ City: _____ State: _____ ZIP: _____Date of Lien.

2 _____I, the undersigned, under the penalties of perjury do solemnly swear (or affirm) that I am the owner or legal agent of the owner of the above described vehicle and that the statements contained herein are or Legal Agent of OwnerState of Oklahoma , County of _____ :Subscribed and sworn to before me this _____ day of _____, commission expires _____, _____. _____, Notary PublicNotary SealOklahoma Tax Commission, Motor Vehicle Division Mailing Adress: Oklahoma Tax CommissionMotor Vehicle Division2501 North Lincoln BoulevardOklahoma City, OK 73194-0013 Telephone.

3 (In-state toll free) 1-800-522-8165 or (direct) (405) 521-3221A listing of Oklahoma tag agency locations and contact information is located in the Motor Vehicle section of the Okla-homa Tax Commission website at 701-6 Part 2 The owner/legal agent of owner of the vehicle described on the reverse side of this Application must complete the follow-ing Declaration.(1) Has the vehicle been damaged by collision or other occurrence? _____ Yes _____No(2) Has the vehicle been recoverd from a theft? _____ Yes _____NoIf the answer to either of the above questions is yes, the owner/legal agent declares, to the best of his/her knowledge:(3) The cost of repairing the vehicle to a roadworthy condition amounted to _____% (percent) of its fair market vaule at the time of Identification Number: _____Odometer Reading.

4 _____I, the undersigned, hereby certify that I have physically inspected the vehicle identification number and odometer reading of the described vehicle, confirming each as entered directly _____ Inspector Date_____ Title or Position_____ _____ _____ City State Motor License Agent Number (if applicable) If the vehicle has been subject to flood or water damage, the owner/legal agent is to also review and answer the following:47 Section 1105 defines Flood-damaged vehicle as follows: Flood-damaged vehicle means a salvage or rebuilt vehicle which was damaged by flooding, or a vehicle which was submerged at a level to or above the dashboard of the vehicle and on which an amount of loss was paid by the insurer.

5 (4) Did the flood/water damage to your vehicle meet the above criteria? _____ Yes _____No_____ _____ Owner or legal agent of owner DateDeclaration of Damage or TheftFlood Damage DisclosureVehicle Inspectio